1. Physiological and Psychological Changes of Pregnancy

2. Reproductive Organ Changes   Uterus   enlargement -- 2 ounces to 2 pounds   rises out of pelvic area and displaces the intestines   changes in tissue   increase in vascularity   hypertrophy   isthmus of uterus softens -   uterine souffle   Patient teaching   Braxton-Hicks contractions Hegars Sign

3.   Cervix   softens - Goodells sign   fills with a mucus plug   increase in discharge, leukorrhea   Vagina   increase in vascularity - Chadwicks sign   increase in discharge, leukorrhea   pH rises and become more susceptible to yeast infections Mrs. Andrews complains of a whitish discharge. What is the teaching regarding vaginal discharges?

4.   Perineum   increased vascularity and pressure causes vulvar varicosities   What should the nurse teach regarding decreasing the pressure in the perineal area?   Ovaries   corpus luteum remains functioning and there is NO ovulation or menstruation. Mrs. Andrews asks why she stops having menstrual periods while pregnant. What is the nurses response ?

5.   Breasts   Growth of alveolar tissue   Nipples become more pigmented   Mrs. Andrews states that her breasts are more full and have become very heavy. What teaching should the nurse include?

6. Respiratory Changes – –The body adjusts to meet the oxygenation needs by: » »Thoracic rib cage is pushed upward and the diaphragm is elevated as uterus enlarges » »Lower thoracic cage widens to increase tidal volume » »Oxygen consumption is increased to support fetus – –Vasodilation of vessels in nose causing epistaxis and nasal stuffiness n n

7. Respiratory Changes n n Nursing Care – –Instruct that because of shortness of breath and dyspnea may need to: » »sleep in an upright position » »avoid overloading the stomach » »stop smoking! – –Nasal stuffiness is normal because of increase in hormones

8. Cardiovascular Changes n n Circulatory System – –Related to: » »cardiac enlargement » »vasodilation » »increase blood volume, hemodilution » »increase cardiac output – 30-50% n n Variations in common laboratory tests – –Hgb – 12 – 16 g/dl – stays about the same – –Hct -- 37% decreases RT hemodilution. There is an increase of about 1500 cc. Over 1000 cc of that is plasma. – –RBC -- ~5.7million which is about a 17% increase.

9. Cardiovascular Changes Nursing Care – –Avoid supine hypotension by side lying – –Arise slowly from a lying position – –Wear support hose and avoid constipation to decrease formation of varicose veins – –Instruct that palpitations may be felt and are normal

10. Gastrointestinal Changes n n Nausea and Vomiting – –Related to: » »increased levels of HCG » »changes in CHO metabolism » »fatigue –Nursing Care » »Avoid offending odors » »eat dry CHO (crackers) upon wakening » »Eat 5-6 small meals per day » »Avoid spicy, gas forming foods » »Drink carbonated beverages

11. Gastrointestinal Changes –Nursing Care » »avoid large meals » »use good posture » »Take low Sodium antacids -- n Heartburn and Indigestion –Related to: »slowing of motility and digestion because of progesterone »relaxation of cardiac sphincter, regurgitation occurs »stomach displaced upward and compressed by enlarged uterus

12. Gastrointestinal Changes n n Constipation – –Related to: » »slowing of motility » »intestinal compression » »oral iron supplement –Nursing Care » »Increase water and fiber in diet » »moderate exercise » »**Don’t take laxatives or enema without a doctor’s permission

13. Gastrointestinal Changes n n Hemorrhoids – –Related to : » »pelvic congestion » »straining with stool –Nursing Care » »avoid constipation » »Apply topical agents to area

14. Review n n Mrs. Andrews says that she just mixes up some baking soda and that takes care of her indigestion. n n Is there any teaching that needs to be done in this situation?

15. Urinary Changes n n Renal Changes – –Related to: » »Kidneys increase in size and weight to enable greater filtration » »Enlarged uterus presses on kidneys and ureters reducing effective flow. » »ureters dilate » »Urinary stasis

16. Urinary Changes n n Urinary frequency and urgency – –Related to: » »pressure of uterus on bladder Nursing care Kegels exercises Limit fluid intake before bedtime Report dysuria or burning

17. Skin and Hair Changes n n Skin – –Increase pigmentation RT increase in production of melanotropin » »face = chloasma » »breasts = areola darkens » »abdomen = linea nigra – –Spider nevi on face and upper trunk – –Striae gravidarum n nHair – –Increase in hair growth

18. Musculoskeletal Changes n n Joints, bones, and teeth – –Softening of pelvic cartilage and exaggerated elasticity of connective tissue can lead to unstable gait – –Posture changes – –Leg cramps – –Carpal tunnel syndrome – –Teeth--there is no demineralization – –Nursing Care   Wear low heel shoes for support   Exercises   Walk leading with the heel of the foot   Wrist supports until after delivery assist with pain related to carpal tunnel syndrome. Goes away after delivery.

19. Weight Gain n n Normal weight gain is about 25 lbs. n n Be sure to teach about good nutrition

20. Hormones n n Endocrine – –The placenta produces new hormones: » »Human chorionic gonadotropin – maintain pregnancy » »Human placental lactogen – antagonist of insulin » »Estrogen – stimulates development of uterine lining » »Progesterone – maintains pregnancy » »Relaxin – aids in softening the cervix

21. n n The End return